Urinary incontinence is the accidental loss of urine.
Urinary incontinence occurs twice as often in women as in men and is more common as women get older. If left untreated, urinary incontinence can interfere with daily activities and lead to decreased quality of life. The October 24/31, 2017, issue of JAMA includes an article about urinary incontinence in women.
The bladder is a balloon-shaped structure with muscular walls that stores urine. During urination, urine travels from the bladder through a small tube called the urethra to exit the body. Muscles surrounding the urethra normally contract to prevent urine leakage until an individual intends to urinate.
Stress incontinence occurs when the muscles surrounding the urethra do not squeeze strongly and urine leaks out through the urethra accidentally. This often occurs during activities that increase pressure inside the abdomen, such as laughing, sneezing, or exercising. Vaginal childbirth or activities such as repeated heavy lifting can affect the function of the muscles of the pelvic floor and lead to stress incontinence. Urgency incontinence occurs when a strong urge to urinate occurs at the wrong time or place. Urgency incontinence often does not have a single clear cause. Women with neurologic conditions that affect the nerves that travel from the brain to the bladder can have urgency incontinence. Mixed urinary incontinence typically involves aspects of both stress incontinence and urgency incontinence. Incontinence may also be caused by urinary tract infections.
The diagnosis of urinary incontinence begins with a detailed medical history performed by a health care professional. A physical examination may be performed to assess the anatomy of the pelvic region. A test of the urine (urinalysis) should be obtained to check for evidence of infection. A voiding diary may be used to document the amount and timing of fluid intake and urine output to aid the diagnosis. If the diagnosis remains uncertain after these initial evaluations or the symptoms do not improve after initial treatments, additional tests may be needed.
Treatment for urinary incontinence should be personalized based on the frequency and severity of symptoms and on individual patient preferences and goals of therapy.
Behavioral strategies such as reducing caffeine intake, drinking small amounts of fluid frequently rather than large amounts of fluid all at once, and scheduled voiding may reduce episodes of incontinence.
Pelvic floor muscle exercises involve repeatedly contracting the muscles of the pelvic floor to strengthen them and help control urination.
For urgency incontinence, medications may be considered if behavioral strategies and pelvic floor muscle exercises are not effective.
For stress incontinence, vaginal devices, including pessaries or over-the-counter inserts, may be particularly helpful if inserted prior to engaging in specific activities that trigger incontinence (such as exercise).
Surgery or other procedures may be considered if urinary incontinence persists despite more conservative therapies. The midurethral sling is a mesh sling that is placed under the urethra in a short outpatient surgery to treat stress incontinence. For treatment of urgency incontinence, injecting onabotulinumtoxinA (Botox) into the bladder wall or electrically stimulating nerves either in the leg or in the lower back (a process called neuromodulation) may be considered.
National Institute of Diabetes and Digestive and Kidney Diseaseswww.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women
To find this and other JAMA Patient Pages, go to the For Patients collection at jamanetworkpatientpages.com.
Sources: American College of Obstetricians and Gynecologists, National Institute of Diabetes and Digestive and Kidney Diseases
Chang HJ, Lynm C, Glass RM. Urinary incontinence in older women. JAMA. 2010;303(21):2208.
Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. doi:10.1001/jama.2017.12137
Christopher C. Muth. Urinary Incontinence in Women. JAMA. 2017;318(16):1622. doi:10.1001/jama.2017.15571